Introduction: The Portsmouth Healthy Food Pantry Initiative produced an adapted CHANGE tool to effect policy, systems and environmental (PSE) change to improve the nutritional content of food pantry distributions to patrons with, or at risk of, diabetes.

Approach: Quantitative surveys of food pantries identified food distribution factors and pantry patron diabetes prevalence. Food Pantry policy environment was assessed. Nutritional content of food was measured using Foods to Encourage (F2E) guidelines. Knowledge, Attitudes, and Beliefs (KAB) surveys measured willingness to change PSE to provide (staff) or choose (patrons) healthier food options. CDC CHANGE Tool was adapted to recommend and measure PSE modifications to improve nutrition content. A case-matched cohort study with 6 pantries measured changes in nutritional content based on F2E for pantries (n = 6) and HbA1c for patrons (n = 103).

Results: None of pantries (n = 10) met goal of 75% F2E in pre-packed food bags (Median = 41%). One of 22 pantries had nutrition policy. Of 227 patrons surveyed, 75% already diagnosed with, or at high risk of, diabetes. Initial KAB results showed pantry staff: chose healthier options than clients; doubted clients’ ability to choose healthier options; and, willing to implement PSE changes. Majority of patrons would choose healthier foods if offered. CHANGE Tool recommendations ongoing, expect to see improvement in F2E proportions and reduced HbA1c in patrons.

Discussion: PSE changes at local food pantries offer opportunity to prevent/reduce prevalence of diabetes in food insecure through better nutritional content. Nutrition education with staff/patrons would improve outcomes.